The Community Engagement Partner Assessment (formally known as the Stakeholder Assessment form) is to be completed by community partners engaged by the hospital Applicant as part of the Determination of Need (DoN) Community-Based Health Initiative (CHI) application process. That process includes the submittal of the Community Health Needs Assessment (CHNA) and Community Health Improvement Plan (CHIP) that the DoN Applicant reports as part of federal and state guidelines. You are being given this form because the Applicant has identified you as an engaged partner in this process.

Assessment overview

This form is designed to elicit objective feedback on the levels of Community Engagement throughout the CHNA/CHIP process from the perspective of community members and partners. Department of Public Health (DPH) evaluation of the submitted Community Engagement Partner Assessment forms are used to ensure consumers and the community at-large are appropriately engaged. This assessment provides additional insight for DPH specifically for decision-making processes used to comply with DoN CHI requirements. This form is being provided to you by the Applicant, and the Applicant is responsible for ensuring this form gets completed.

Completion of this form is voluntary; however, it is necessary for the Applicant to demonstrate compliance with DPH Community Engagement Guidelines and partner feedback is an integral component to that. Your feedback is critical to understanding the quality of community engagement conducted for CHI.

DPH will be using information from these forms in summary format only. Questions about this process can be directed to DONCHI@state.ma.us.

Related: Learn why we are switching to partner instead of stakeholder, Research Impact Canada | Indigenous Terms on British Columbia